MEDICARE: FAMILY CARE OF SOUTHERN ARKANSAS, LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	E-1050	AR

General Provider Information

NPI Number	:	1790050466
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY CARE OF SOUTHERN ARKANSAS, LTD

Provider Business Mailing Address
First Line	:	11001 EXECUTIVE CENTER DR
Second Line	:	SUITE 200
City	:	LITTLE ROCK
State	:	AR
Zip	:	72211-4316
Country	:	US
Telephone Number	:	501-812-7800
Fax Number	:

Provider Business Practice Location Address
First Line	:	3108 N WEST AVE
Second Line	:
City	:	EL DORADO
State	:	AR
Zip	:	71730-2731
Country	:	US
Telephone Number	:	870-863-9020
Fax Number	:

Authorized Official
Title or Position	:	MD/OWNER
Name	:	ROBERT A WATSON II
Credential	:	MD
Telephone Number	:	870-863-9020

Provider Enumeration Date	:	03/14/2012
Last Update Date	:	03/14/2012

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